No Prenatal Care? …..What are YOU Hiding??
I read so much in various blogs about beautiful births or births where mothers have planned for beautiful births and then may have received sub-optimal care, things went awry or not as planned and they have every right to be upset or angry. What about the some of those moms out there who do no planning what so ever? What is their story?? Sometimes it’s ugly…. very ugly.
I am supposed to be working on my cultural breastfeeding project… but alas– since I am having SO much trouble gathering the info and data that I need…. I’ve directed my energy to one of my other committee projects. We are revising our current Maternal / Infant Drug Screening and Neonatal Abstinence Syndrome (NAS) Screening Policy. I thought, I’m hoping…. that this may be interesting reading for some of you. Maybe you can help and give me your thoughts, your ideas…..
This post is NOT in conflict with my current views of women educating themselves and deciding for a birth of their choice whether it be a homebirth or unassisted birth…… I am very much in support of an individual mother’s educated choice or decisions.
No– This is about those individuals who do not educate themselves and who do NOT seek any prenatal care. (No Prenatal Care = NPC) ..We have to ask what are you hiding???? We, the staff, become detectives. We check out all your stories and we check them out carefully. Sometimes, we just don’t believe you…. we always take the baby’s side!
Warning….. you are going to see a little of my darker, non-trusting side for a change….
Most common reasons for NPC or Late Entry to Prenatal Care seen at my facility:
- #1 reason— Illicit street drug use—- the most common? THC (cannabis or marijuana), Cocaine, and Opiates
- Abuse by an intimate partner… both violent and non-violent (Isolated from friends/family)
- Alcohol abuse without other substance abuse
- Adolescent Pregnancy- hiding pregnancy from other family members
- Fleeing Children and Youth agencies were they live and are possibly under review or have lost custody of other children for various reasons….
- Diminished mental capacity with inadequate support systems
- Low socio-economic group with limited or no access to transportation (Why are these the people with huge amounts of visitors… we have to ask-how did those visitors get here?? And where were they- with their cars during the pregnancy?)
There have been some women who sometimes don’t seek prenatal care because of cultural reasons especially if there is not a local female provider and it is against their religion or culture for a male to care for/examine them. This has happened here ….but not often.
When patients arrive in labor or for labor checks, and we don’t have any records available to us…the following situations lead us to suspect NPC :
- “I’m visiting here for the weekend…my doctor is in NYC or NJ” –yet unable to provide a name or #
- “I just moved up here and I didn’t get my records transferred” — yet unable to provide a name or # (Sometimes with either of these situations, we are provided with a ficticious doctor’s name associated with a real hospital)
- Drug seeking behavior
- Conflicting information on prenatal care…. always a different story..
- Stories of other children not living with them “right now”..
- “I’m just here on vacation and I didn’t know I was pregnant…”….”I swear!” (that a whole other story!)
There are a few other situations which, even though we have access to prenatal records,
lead us to believe there could possibly be illicit illegal substance abuse:
- Very late entry into prenatal care … late 2nd or 3rd trimester (chaotic lifestyle)
- Arrival in 3rd trimester with bleeding.. especially a spontaneous abruption
- Unexplained sudden elevated blood pressure without associated symptoms
- Prematurity- preterm labor, premature rupture of membranes
- Inappropriate behaviors
- Noncompliance with provider recommendations for care…without explanation
- Unexplained IUGR … Intrauterine Growth Restriction
- Newborns with irritability, high-pitched cry, tremors, hypertonicity, vomiting, diarrhea and or tachypnea or other symptoms of withdrawal.
Gosh this isn’t like me….
I feel so pessimistic right now. I have seen each and every one of these situations or excuses and
I have seen them many times.
I need to say before I go on… that those individuals who are victims of domestic violence or have diminished mental capacities without proper support mechanisms…even those who may really have no access to transportation…. and young teens afraid to tell your families…..You are all in need of extra support and we have been trying to make sure the proper support mechanisms are there for you once you enter into the health-care system.
That being said, the Drug Screening policy and protocols for our facility must be comprehensive to protect the newborn. When you do not have prenatal care, we become detectives to rule-out anything which can be harmful to your baby. Because illegal illicit drug use during pregnancy poses a danger to the newborn and because it is often a top reason for mother’s to avoid prenatal care…. our Perinatal Committee is intending to include all of the following in mandatory admission (urine for mother; urine and meconium for baby) drug screening protocols:
- Any history of drug use either during this pregnancy, previous pregnancy or admitted past drug use (including past history of rehab)
- Any mother in current rehab or in a methadone program
- Any postive drug screen during the pregnancy… for any substance
- Any clients flagged by Children and Youth to check for drug use during pregnancy upon arrival to L&D
- No Prenatal Care
- Conflicting history of PNC elsewhere…. unable to obtain records
- History of loss of custody or loss of parental rights for other children
- Late entry into prenatal care especially with unexplained noncompliance
- Third trimester bleeding
- Sudden unexplained placental abruption
- Significantly elevated BP without associated symptoms
- Drug seeking mother’s without a diagnosis requiring pain management
- “Drive-by” deliveries.. no available confirmed prenatal care upon admission
- Unexplained IUGR or Small for Gestational Age (SGA)
- Newborns who develop symptoms of withdrawal (NAS)
I just might have forgotten something because I don’t even have my perinatal committee minutes here with me. It is in the works. This is an extensive list, I know. Some of you may feel this is an invasion of privacy. I do not. I feel the mother should be told her urine is being tested given sufficient cause as per our protocol. There are many which will come up negative…I hope that happens MOST of the time. I believe our protocol should be consistently followed. Some states require mandatory HIV testing in pregnancy. Currently in PA we don’t. We may have many HIV positive mothers come through our doors to give birth and the baby never receives antivirals.
I will leave you with a story…… I have seen many mother’s come through with stories or explanations and I have been so trusting, so believing and defending them. Recently I encountered a mother from NYC who came to my hospital to give birth prematurely…. about 36 weeks.. a Mupfer…(“I’m up for the weekend”). She had provided us with a card of prenatal info (which later turned out to be fabricated) and told us she had lost all of her other babies..perinatal losses. She gave details etc… We all felt sorry for her. Her baby was small and developed mild respiratory issues then after 24 to 30 hours was in obvious full withdrawal. Turns out– she had fled the New York City Family Services and gave birth with us in PA because she had lost custody of all 5 of her children due to continued heroin and cocaine addiction. The baby tested positive for both once we tested him. The mother skipped out when we confronted her. Our Children and Youth Services took protective custody of the baby. He was properly treated and was discharged to a foster home on medication.
As much as I believe in choice and informed decision for mothers …
I believe also in protection of the innocent newborns.